Healthcare Provider Details

I. General information

NPI: 1568835817
Provider Name (Legal Business Name): MELISSA MAIHOFER MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 ARBORWOODS DR
BROWNSBURG IN
46112-7740
US

IV. Provider business mailing address

1542 ARBORWOODS DR
BROWNSBURG IN
46112-7740
US

V. Phone/Fax

Practice location:
  • Phone: 330-858-0148
  • Fax:
Mailing address:
  • Phone: 330-858-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31001028A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: